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PURPOSE: To identify and assess predictors of short-term outcomes and a prolonged length of hospital stay after head and neck cancer surgery in older-old and oldest-old patients. PROCEDURES: Patients aged ≥75 years with head and neck cancer undergoing surgery at the Brazilian National Cancer Institute from January to December 2011 were assessed regarding postoperative complications, mortality, and length of hospital stay. RESULTS: Over the study period, 67 patients with head and neck cancer underwent surgery, 44.8% of whom developed complications within 30 days of surgery, surgical site and respiratory infections (29.9 and 20.9%, respectively) being the most common. The mean length of hospital stay was 7 days (range: 2-26). In multivariate analysis, previous radiotherapy, dependence in instrumental activities of daily living, and low serum hemoglobin (≤13.2 g/dl) were predictors of complications. In addition, the presence of at least 1 clinical or surgical complication, smoking, and an arm circumference ≤25 cm were independent predictors of a prolonged length of hospital stay. CONCLUSIONS: Complications after head and neck cancer surgery in the elderly are common and related to the prolonged length of hospital stay, both being influenced by previous radiotherapy, smoking, functional dependence in instrumental activities of daily living, and nutritional conditions. Such predictors should be considered in a preoperative assessment of elderly patients as these are modifiable risk factors.

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INTRODUÇÃO: O objetivo deste estudo é identificar os preditores, em curto prazo, de complicações pós-operatórias, mortalidade e tempo prolongado de internação hospitalar em cirurgia para tumores malignos de cabeça e pescoço em pacientes muito idosos. METODOLOGIA: Foram incluídos no estudo 67 pacientes com câncer de cabeça e pescoço submetidos a cirurgia. Foram avaliados pacientes com idade ≥ 75 anos com neoplasia de cabeça submetidos a cirurgia no Instituto Nacional de Câncer ( INCA) , entre Janeiro e dezembro de 2011. Foram avaliados complicações pós-operatórias, mortalidade, e tempo de internação prolongado. As características dos pacientes e da doença, incluindo o estado nutricional e funcional foram avaliados, bem como os preditores de complicações pós-operatórios usando modelos de análise bivariada e multivariada e regressão logística. Valores de p<0.05 foram considerados estatisticamente significantes. Resultados: Entre os pacientes submetidos a cirurgia, 44,8% desenvolveram complicações nos 30 dias que antecederam a alta hospitalar . Infecção em ferida operatória (29,9%) e pneumonia (20,9%) foram as complicações mais comuns. A mediana para internação hospitalar foi de sete dias (2-26 dias) . A análise multivariada mostrou que radioterapia prévia (OR= 12,5; IC 95%: 1,2-130,3; p= 0.03) , dependência nas Atividades Instrumentais de Vida Diária (AIVD) (OR= 6,2; IC 95%: 1,9-20,0; p= 0.002) , e baixo nível sérico de hemoglobina ≤13,2 g/dL (OR= 3.3; IC 95% 1,0-10,5; p= 0.045) foram preditores de complicações. Além disso, a presença de uma complicação clínica ou cirúrgica (OR= 33,2; IC 95%: 5,5-200,8; p< 0.001) , tabagismo (OR= 11,0; IC95%: 1,5-81,1; p= 0.02) , e circunferência do braço ≤ 25 cm (OR= 7,2; IC 95% 1,2-44,6; p= 0.003) foram preditores do tempo de internação prolongado...

Background: This study aimed at identifying and assessing predictors ofshor t- term outcomes and prolonged length of hospital stay (PLOS) af ter head and neck cancer (HNC) surgery in older -old and oldest-old patients. Methods: This study assessed patients aged ≥ 75 years with HNC undergoing surgery at the Brazilian National Cancer Institute ( INCA) between January and December 2011. Postoperative complications, mor tality, and PLOS were evaluated. Character istics of the patients and disease, including nutr itional and functional statuses, were evaluated as predictors of postoperativecomplications using bivar iate and multivar iable logistic regression models. An alpha level < 0.05 was considered to be statistically significant. Results: Over the study per iod, 67 patients with HNC underwent surgery, 44.8% of whom developed complications within 30 days of hospital discharge. Surgical site infection (29.9%) pneomonia(20.9%) were the most common complications. The median hospital length of stay was seven days (2-26 days) . Multivar iateanalysis indicated that previous radiotherapy (OR= 12.5; 95% CI: 1.2-130.3; p= 0.03) , dependence in instrumental activities of daily living ( IADL) (OR= 6.2;95% CI: 1.9-20.0; p= 0.002) , and low serum hemoglobin ≤ 13.2 g/dL (OR= 3.3; 95% CI: 1.0-10.5; p= 0.045) were predictors of complications. In addition, thepresence of at least one clinical or surgical complication (OR= 33.2; 95% CI: 5.5-200.8; p < 0.001) , smoking (OR= 11.0; 95% CI: 1.5-81.1; p= 0.02) , and arm circumference ≤ 25 cm (OR= 7.2; 95% CI: 1.2-44.6; p= 0.003) wereindependent predictors of PLOS...

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PURPOSE: To measure the thickness of adductor pollicis muscle in healthy adults. This measurement will be used as a nutritional anthropometric parameter in further studies. SUBJECTS AND METHOD: Four hundred and twenty-one healthy adults were studied, 209 men and 212 women, with ages ranging from 18 to 87 years, living in Rio de Janeiro. The adductor pollicis muscle was also studied in the human anatomy lab as well as in normal healthy volunteers using CAT scans and nuclear magnetic resonance imaging to ensure that only the adductor pollicis was included in measurement of muscle thickness with a Lange caliper. To standardize the measurement, the methodology was detailed, with subjects sitting with the dominant hand dangling over the homolateral thigh and the elbow bent at approximately a 90 degrees angle. The Lange caliper was applied at a pressure of 10 g/mm2, pinching the adductor pollicis muscle at the vertex of an imaginary angle between the thumb and the index finger. The average of 3 consecutive measurements was considered to be the muscle thickness. RESULTS: This study provides the first estimates of adductor pollicis thickness in normal healthy subjects as an anthropometric parameter. The normal values in the dominant hand for men were 12.5 +/- 2.8 mm (mean +/- SD), median 12 mm, and for women were 10.5 +/- 2.3 mm, median 10 mm.

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PURPOSE OF REVIEW: Contraction of the adductor pollicis muscle after electrical stimulation (electromyogram) or dynamometry (hand-grip tests) has been evaluated in a variety of clinical conditions as a parameter to assess nutritional status. However, adductor pollicis muscle thickness has not been investigated as an anthropometric parameter. RECENT FINDINGS: Prolonged immobilization and non-use of lower and upper limb muscles causes atrophy. Adductor pollicis muscle function is normal in patients with stable chronic obstructive pulmonary disease and multiple sclerosis, whereas the musculature of lower limbs suffers more pronounced functional alterations. Structure and function are relatively preserved in upper limb muscles, probably because of the maintenance of some daily activities involving the arms. Inactivity as a result of a reduction in daily activities is probably the driving factor for these changes. Forearm immobilization for 21 days caused no significant change in muscle morphology, but caused a deterioration in muscle function. Virtually all routinely developed activities requiring opposition of the thumb muscle and repetitive exercise of one muscle group for a given period of time maintain muscle size and function. Apathy is often observed as malnutrition progresses, reducing daily working activity and aggravating adductor pollicis muscle loss besides the muscular catabolism caused by disease. SUMMARY: This study provides the first estimates of adductor pollicis muscle thickness in normal healthy individuals. The adductor pollicis muscle has a positive correlation with anthropometric variables that estimate muscle mass, but fails to correlate with parameters that estimate fat mass. This measurement is now being evaluated as an anthropometric parameter in clinical studies.

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OBJETIVO: Padronizar a medida da espessura do músculo adutor do polegar em adultos saudáveis, para futuras avaliações como parâmetro antropométrico. INDIVÍDUOS E MÉTODOS: Foram estudados 421 adultos saudáveis, oriundos de vários municípios do Rio de Janeiro, de ambos os sexos e nas faixas etárias compreendidas entre 18 a 25 anos, 26 a 45 anos, 46 a 65 anos e mais de 65 anos. Após a confirmação pelos estudos radiológicos e anatômicos, concluindo que com a técnica empregada, nenhum outro músculo além do adutor do polegar foi incluído na medição, foi elaborado o seguinte método: Com o indivíduo sentado, mão dominante repousando sobre o joelho homolateral, cotovelo em ângulo de aproximadamente noventa graus sobre o membro inferior, foi utilizado o paquímetro de Lange exercendo uma pressão contínua de 10g/mm2 para pinçar o músculo adutor no vértice de um ângulo imaginário formado pela extensão do polegar e o dedo indicador. A média de três aferições foi considerada como a medida da espessura do músculo adutor. RESULTADOS: A média obtida para a espessura do músculo adutor do polegar, na mão dominante, no sexo masculino foi de 12,5 ± 2,8 mm, com uma mediana de 12 mm e no sexo feminino foi de 10,5 ± 2,3 mm, com uma mediana de 10 mm.

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O autor estudou 421 adultos saudáveis, de ambos os sexos, oriundos de vários municípios do Rio de Janeiro, com idade variando de 18 a 87 anos. A avaliação nutricional foi realizada com os parâmetros antropométricos clássicos, Avaliação Global Subjetiva e avaliação subjetiva do estado trófico da musculatura temporal superficial, interóssea das mãos, adutora do polegar e panturrilhas. Nenhum indivíduo apresentou desnutrição quando considerado no mínimo dois parâmetros nutricionais antropométricos, nem quando avaliados pela Avaliação Global Subjetiva. Alguns resultados da antropometria clássica contrastam com os descritos em tabelas americanas, principalmente quanto a reserva gordurosa e muscular, em ambos os sexos. Esse achado enfatiza a necessidade de se obter os resultados antropométricos para nossa população saudável. A medida da espessura do músculo adutor do polegar na mão dominante foi padronizada, com relato detalhado da metodologia utilizada. A média para o sexo mesculino foi de 12,5 mm e a do sexo feminino foi de 10,5 mm. Em indivíduos saudáveis, a prevalência de atrofia da musculatura temporal superficial, adutora do polegar, interóssea e da panturrilha é extremamente rara.

The author studied four hundred and twenty one healthy adults (209 men and 212 women) with age ranging from 18 to 87 years old, living in Rio de Janeiro. Nutritional assessment was determined with classical anthropometrics parameters, Subjective Global Assessment and subjective appraisal of muscle trophic state from superficial temporal muscle, interosseus, adductor pollicis e calves. Considering at least two nutritional anthropometries parameters, malnutrition were not detected in any of adult and SGA were normal in all subjects. However, some results obtained from classical anthropometries measures were not comparable with populational american tables. The amount of fat and protein reserves were quite different both in men and women. These data emphasize that normal anthropometries values are needed to healthy brazilian population. The prevalence of subjective atrophy of superficial temporal, interosseus, calves and adductor pollicis muscle were extremely rare. This study provides the first estimates of adductor pollicis thickness as a new anthropometric parameter. The methodology is detailed and the normal values in nondominant hand were considered 12,5 mm in men and 10,5 mm in women.

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